Misuse of Metered Dose Inhalers by House Staff Members

Sir.—Medications deliveredbyinhaled aerosols have become the therapy of choice for management of hyperreactive airway disease.^1,2 Many aerosol preparations containing B-agonists, anticholinergic agents, steroids, and cromolyn sodium are available. Medications administered via inhalation are preferred to oral medications because the drug is delivered directly to airway receptor sites in the lungs. Therefore, lower doses can be used, the onset of action is usually more rapid, and the incidence of side effects is reduced. Because of advances in pharmacology and developments in respiratory physiology, metered dose inhalers are the preferred method for delivery of asthma medications. It is not unusual for patients to require two or three different metered dose inhalers (MDIs) for asthma control. However, the patient must perform a complex series of maneuvers to successfully use the MDI. A number of surveys have shown that anywhere from 14% to 75% of patients in hospital clinics who use